Here’s an update from the Performing Arts Medicine Association on the latest thinking about singing and long Covid.

A year ago, BAST spoke to singer and vocal coach Sarah Nixey about her post-Covid vocal recovery. Back then, long Covid was a new phenomenon, one that the medical community was still struggling to understand.

While there are still many unanswered questions, thankfully, our knowledge of how the condition can impact a singer has grown since then.

The Performing Arts Medicine Association (PAMA) recently covered the subject in a webinar: Returning to the Stage – Performing Artists and Arts Organizations Dealing with Covid Long Haulers Issues. Here are six takeaways from the talk.

1 More singers are presenting with Covid-related issues

Dr Lucinda Halstead, PAMA President and Medical Director, Evelyn Trammell Institute for Voice and Swallowing, says she’s seeing more and more singers with long Covid.

“During the pandemic, I saw few people affected by Covid,” she says. “I think that’s because they were so sick that they weren’t coming out. Now I have a lot more patients who have had Covid and are grappling with this.

“For those who have been severely affected by Covid-19, the results of the disease on the lung parenchyma can be devastating.”

Dr Halstead says she’s seeing singers with:

– Deconditioning of the respiratory muscles.

– Decreased capacity.

– Injuries caused by compensatory strategies. 

– Traumatic lesions as a result of intubation.

She also talks (10 minutes in) about respiratory muscular training (she’s a big fan and recommends the PowerBreathe Medic Plus).

Allen Henderson, vocal coach, singer and executive director of the National Association of the Teachers of Singing (NATS), also shares his thoughts (25 minutes in.) Here’s a rundown of his take on singing and long Covid.

2 A flexible approach 

Long Covid is often episodic, with patients feeling ok one day and in pieces the next; this presents a challenge for teachers with a very methodical approach. “We have to be careful and understanding of each case that walks in our door.”

3 Beware of misinformation

There is a wealth of misinformation about long Covid on the web. Singing teachers need to make sure the resources they access are backed up by research (which can be difficult as it’s a new condition).

4 Post-exertional malaise

This is a common issue with Covid long haulers. A singer can feel fine during and immediately after a short lesson – but be wiped out 24 hours later. “Often, we’re looking at the immediate. Am I taking a careful approach? Do they seem strained? We have to be cognizant of this [post-exertional malaise] as we plan strategies with our students.”

This fatigue can be the result of physical, cognitive or sensory overload. When we sing, there is a risk of physical overload as we use the entire body as an instrument. But singing also involves complex cognitive tasks – language, interacting with others on stage and acting – that could also cause potential overload for the post-Covid patient.

5 Team approach

“Many of us have for years been advocating a team approach [to helping a singer recover from vocal injury]. 

“If you’re a singer, I want to urge you to invite your teacher into this team and make sure that they’re aware of the type of things that you’re talking to your doctor about. Take a moment to discover what you feel after a session so you can take the results of a session back to the medical therapists. They can plug that data into the overall treatment plan.”

6 Lesson planning

(35 minutes in)

“We need to map out a plan and shorten and simplify things. We can’t have that first face-to-face lesson and just say, ‘I heard this at our last online lesson, let’s hit it’. Take that first face-to-face lesson as a diagnostic opportunity. Try to evaluate where that student is and make sure that the things you heard over Zoom are truly evident in the face-to-face situation.”

Don’t assume that the student has progressed as much as you think they have. Chances are, some have progressed well, and some haven’t.

Think about strategies for these first in-person lessons. Singers with long Covid may need shorter lessons or to sit – standing may be a huge exertion on their system.

Consider lengthening the warm-up time, and adjusting breath and volume so that the singer is not going to extremes. Be aware that you’re not overloading students with too many instructions. Make sure there is time to return to a quiet breathing state at the end.

Other resources

Workwell Foundation offers advice for people with fatigue-related illnesses.

ENO Breathe 

Breathe, Sing, Move with Rachel Goldenberg.